Provider Demographics
NPI:1952730921
Name:JORDAN, BROOKE AMELIA
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:AMELIA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BIRDIE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8611
Mailing Address - Country:US
Mailing Address - Phone:252-567-7821
Mailing Address - Fax:252-200-4388
Practice Address - Street 1:107 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3739
Practice Address - Country:US
Practice Address - Phone:252-200-4388
Practice Address - Fax:252-200-4388
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-10
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-064-025253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care